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that " location " in the sense, say, of a family all suffering from malaria does not
count, further the question of contagion scarcely arises, the spacing and distribution
of those affected showed no point in favour of such a conclusion. A further significant
fact was that one father and three mothers and four brothers and sisters of these
children are said to have died of rheumatic fever or from rheumatic heart disease,
and all these four parents were under forty-five at the time of death. Inherited
susceptibility of diathesis would thus seem to be another link in the chain that fastens
down the rheumatic child. But a constitutional bias does not determine the onset.
There must be some factor, a factor at present unknown, that ignites the tinder.
The history of the illness outlined above leaves little doubt that rheumatism
is an infective illness, but that the virus only establishes itself under certain conditions,
partly caused by poverty. It is widely held that it is mainly among the
decent poor that rheumatism flourishes and that the poorest of the poor escape.
This belief follows the observations of many able physicians, but Dr. J. A. Glover
has pointed out, that it may be those physicians working in hospitals in better class
neighbourhoods seldom see the lowest grades of humanity at their clinics, and that
only the more observant and more careful mothers bring their children to hospital.
Subnormality of the children in very poor homes is so much the rule that often the
parents do not realise that their children are ailing and so do not seek medical aid.
The expectation of life of such children is small; only the fittest of them reach school
age. Such as do are the gamins of the streets and spend their waking hours out
of doors—perhaps meagrely clad, when wind and sun and air can play their beneficial
parts—in contrast to the overdressed and muffled up children of parents toopolite
to allow their children " on the street." Moreover, necessitous children receive
wholesome school meals. Every school doctor knows the difficulty in getting slum
children to go to residential and convalescent homes—such children used to the
haphazard life of squalor and grime take badly to a regular and wholesome regime,
and if sent on a country holiday as often as not they are removed by their parents
or run away.
In these hundred cases, thirty-five came from slumdom and fifty-three more were
borderline slum dwellers. It is only by seeing the homes that any estimate may be
given of the conditions. There are many areas of wretched old tumble-down dwellings
where the inhabitants are decent working folks just as there are areas of good class
terraced houses once the residences of the rich but now parcelled out in single or
double rooms to thriftless, inefficient, often criminal and immoral people, whose
presence and numbers renders such property insanitary in the widest sense.

The figures in the columns 1 to 9 represent the number of families in each house.